Pediatric hand trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
A subungual hematoma in the face of an intact nail plate often presents with severe pain due to pressure beneath the nail. Treatment is aimed toward decompression of the hematoma and is most successful within the first 36 h of injury while the hematoma remains liquefied. These can be drained sterilely by making one or several holes through the disinfected nail plate with a needle or portable cautery. Provided the puncture does not reach the nail bed itself, anesthesia is unnecessary. The finger can then be placed in warm water or hydrogen peroxide to help evacuate the hematoma. However, in the face of a large subungual hematoma, the likelihood of a significant nail bed injury is generally high enough to warrant removal of the nail plate and repair of the bed. Along the same lines, subungual hematomas that are accompanied by disturbance of the nail or its margins require removal of the nail and evaluation of the nail bed .
Complications in Mohs Surgery
Alexander Berlin in Mohs and Cutaneous Surgery, 2014
Hematomas can impair wound healing, cause epidermal necrosis, and serve as a nidus of infection.34 An acute hematoma should be suspected when a patient complains of increasing pain and swelling at the surgical site. Thick “black currant jelly” discharge is a sign of a coagulated, organized hematoma. Hematomas with active bleeding require opening of the wound and hemostasis. Acute hematomas that are not actively bleeding should be evacuated with a large-bore needle and syringe (Figures 4.14 and 4.15). On the other hand, the thick coagulum of a stable and organizing hematoma requires evacuation after sutures are removed or observation if it is small and improving. If hematomas are opened, they should be irrigated and packed with iodoform gauze.34 The authors perform bacterial cultures of hematoma contents and treat with empiric antibiotics, given the increased risk for infection.
Complications of Laparoscopic Radical Prostatectomy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
The two major sites of bleeding during LRP are the dorsal venous plexus and the prostatic pedicles. Adequate ligation of the former and meticulous hemostasis during pedicle dissection will obviate most serious hemorrhage. The actual degree of bleeding can be underestimated visually by the surgeon secondary to insufflation pressure on venous structures. For this reason it is imperative to decrease the insufflation pressure and examine the field for bleeding prior to the conclusion of the operation. Unrecognized venous bleeding during LRP may lead to pelvic hematoma formation. Although some amount of hematoma may be expected, larger hematomas may lead to recurrent fevers, infection, voiding symptoms, urinary retention, pelvic pain, and anastomotic disruption (52). In these cases we have found it best to drain these hematomas either through a percutaneous approach or through a small infraumbilical incision. Although not technically a bleeding complication, lymphocele is a recognized complication of laparoscopic lymphadenectomy and has been noted to occur in 0.1% to 1% of patients (Table 2) (53). If these become symptomatic or infected, percutaneous drainage is also a good treatment modality.
A case of pleomorphic adenoma of the lacrimal gland invading the lower orbit
Published in Orbit, 2022
Ryosei Kado, Satoru Kase, Yuka Suimon, Susumu Ishida
Computed tomography showed an iso-density mass of approximately 2 cm across the upper and lower regions of the right orbit without bone abnormalities. On magnetic resonance imaging (MRI), T2-weighted images showed a tumor with high intensity in the center surrounded by low intensity areas. Coronal sections of MRI showed that the tumor shape resembled a gourd (Figure 1B). Hematoma and neoplastic lesions were clinically considered as differential diagnoses. The tumor was resected with a transcutaneous approach through the upper eyelid. The elastic hard yellowish tumor was exposed under the skin, which was macroscopically different from hematoma (Figure 2A). The tumor was gently separated from the connective tissues thereafter. When the upper part of the tumor was detached, the lower part was gradually isolated as a lump (Figure 2B). Eventually, the tumor could be completely resected as a mass without damage to the capsule (Figure 2C). After the surgery, the appearance of the ocular surface and eyelid improved (Figure 1C), and the intraocular pressure was normalized. There was no recurrence of the tumor during the follow-up period of 6 months.
“Abdominoplasty with “En block” removal of the skin island: a safe and fast approach”
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Mustafa Sutcu, Mustafa Keskin, Naci Karacaoglan
We encountered no problem in closing the abdominal skin in any of the patients. No skin flap necrosis was observed in any patient. Eight patients had minor skin healing problems. Minor healing problems were managed conservatively until the blood supply to the abdominal skin stabilized. A revision of either the excision with reclosure or scar revision was then done. The most frequent complication (n = 22) was the formation of a seroma, which had to be aspirated. The mean number of aspirations was 4 (range, 1–6). A hematoma was observed in one patient. The average final position of the scar was 8.9 cm from the upper vulvar commissure. Scar revision and ‘dog ear’ correction were required in seven patients. Wider scars were directly proportionate to the tension applied on the wound. To date, there have been no cases of thromboembolism. To prevent thromboembolism, we used all possible types of prophylaxis, including having the patient wear postoperative stockings, early mobilization, and postoperative massage of the calves. None of the patients required a transfusion (Figures 2–7).
Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study
Published in International Journal of Hyperthermia, 2021
Xiao-Jing Cao, Ming-An Yu, Ya-Lin Zhu, Lu Qi, Zhi-Bin Cong, Guo-Zhen Yan, Juan Liu, Hong-Ling Wang, Geng Liu, Jian-Qin Guo, Ying Hao, Zhong-Hua Wang, Xue Wang, Jun-Feng He, Aini Shataer, Xiao-Fang Liu, Zhen-Long Zhao, Ying Wei, Li-Li Peng, Yan Li, Shu-Rong Wang, Ying Che
Nineteen (2.6%) patients exhibited major or minor complications during the follow-up period post-ablation. The major complication was voice hoarseness, and the minor complications were hematoma formation and cough. Fourteen (1.9%) patients developed voice hoarseness, 4 (0.6%) patients developed hematoma, and one (0.1%) patient developed choking cough. The clinical characteristics of patients who exhibited hoarseness post-ablation are listed in Table 4. All 14 patients with hoarseness had PTMC located near the posterior capsule or the middle capsule of the thyroid, which was closer to the RLN. Two patients recovered their voice completely within 1 month post-ablation, 4 within 2 months, 4 within 3 months, 1 within 4 months, and 3 within 6 months. All hematomas completely resolved within 2 weeks. The patient who developed cough showed complete recovery within 1 day. None of those complications were life threatening, and all patients recovered from major or minor complications without sequelae. One patient died of myocardial infarction at 6 months post-ablation.
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